Acute heart failure: new diagnostic perspectives for the emergency physician

The topic of heart failure (HF) in the emergency department is today relevant, since there are new serum markers and imaging techniques that may help in the diagnosis of this disease. Natriuretic peptides have now entered the flowchart for etiologic diagnosis in patients with acute dyspnea, when technical facilities are available. Recently, chest ultrasonography has been shown to be useful for the noninvasive assessment of extravascular lung water. Starting from this practical standpoint, we propose that simple chest ultrasonogrpahic signs can provide a totally noninvasive characterization of pulmonary congestion in patients with HF.     

Pulmonary Congestion by Lung Ultrasound in Ambulatory Patients With Heart Failure With Reduced or Preserved Ejection Fraction and Hypertension

Background

Although pulmonary congestion can be quantified in heart failure (HF) by means of lung ultrasonography (LUS), little is known about LUS findings (B-lines) in different HF phenotypes. This prospective cohort study investigated the prevalence and clinical and echocardiographic correlates of B-lines in ambulatory HF patients with preserved (HFpEF) or reduced (HFrEF) ejection fraction compared with hypertensive patients. We related LUS findings to 12-month HF hospitalizations and all-cause mortality.

Lung ultrasound findings in hospitalized COVID-19 patients in relation to venous thromboembolic events: the ECHOVID-19 study

PurposeSeveral studies have reported thromboembolic events to be common in severe COVID-19 cases. We sought to investigate the relationship between lung ultrasound (LUS) findings in hospitalized COVID-19 patients and the development of venous thromboembolic events (VTE).MethodsA total of 203 adults were included from a COVID-19 ward in this prospective multi-center study (mean age 68.6 years, 56.7% men). All patients underwent 8-zone LUS, and all ultrasound images were analyzed off-line blinded. Several LUS findings were investigated (total number of B-lines, B-line score, and LUS-scores).ResultsMedian time from admission to LUS examination was 4 days (IQR: 2, 8). The median number of B-lines was 12 (IQR: 8, 18), and 44 (21.7%) had a positive B-line score. During hospitalization, 17 patients developed VTE (4 deep-vein thrombosis, 15 pulmonary embolism), 12 following and 5 prior to LUS. In fully adjusted multivariable Cox models (excluding participants with VTE prior to LUS), all LUS parameters were significantly associated with VTE (total number of B-lines: HR = 1.14, 95% CI (1.03, 1.26) per 1 B-line increase), positive B-line score: HR = 9.79, 95% CI (1.87, 51.35), and LUS-score: HR = 1.51, 95% CI (1.10, 2.07), per 1-point increase). The B-line score and LUS-score remained significantly associated with VTE in sensitivity analyses.ConclusionIn hospitalized COVID-19 patients, pathological LUS findings were common, and the total number of B-lines, B-line score, and LUS-score were all associated with VTE. These findings indicate that the LUS examination may be useful in risk stratification and the clinical management of COVID-19. These findings should be considered hypothesis generating.Clinicaltrials.gov ID{"type":"clinical-trial","attrs":{"text":"NCT04377035","term_id":"NCT04377035"}}NCT04377035     

B-lines quantify the lung water content: a lung ultrasound versus lung gravimetry study in acute lung injury

B-lines (also termed ultrasound lung comets) obtained with lung ultrasound detect experimental acute lung injury (ALI) very early and before hemogasanalytic changes, with a simple, noninvasive, nonionizing and real-time method. Our aim was to estimate the correlation between B-lines number and the wet/dry ratio of the lung tissue, measured by gravimetry, in an experimental model of ALI. Seventeen Na-pentobarbital anesthetized, cannulated (central vein and carotid artery) minipigs were studied: five sham-operated animals served as controls and, in 12 animals, ALI was induced by injection of oleic acid (0.1 mL/kg) via the central venous catheter. B-lines were measured by echographic scanner in four predetermined chest scanning sites in each animal. At the end of each experiment, both lungs were dissected, weighed and dried to determine wet/dry weight ratio by gravimetry. After the injection of oleic acid, B-lines number increased over time. A significant correlation was found between the wet/dry ratio and B-lines number (r = 0.91, p < 0.001). These data suggest that in an experimental pig model of ALI/ARDS, B-lines assessed by lung ultrasound provide a simple, semiquantitative, noninvasive index of lung water accumulation, strongly correlated to invasive gravimetric assessment.     

Valor pronóstico de la ecografía de pulmón en pacientes ambulatorios con insuficiencia cardiaca crónica estable

Introduction and objectivesThe role of lung ultrasound (LUS) in acute heart failure (HF) has been widely studied, but little is known about its usefulness in chronic HF. This study assessed the prognostic value of LUS in a cohort of chronic HF stable ambulatory patients.MethodsWe included consecutive outpatients who attended a scheduled follow-up visit in a HF clinic. LUS was performed in situ. The operators were blinded to clinical data and examined 8 thoracic areas. The sum of B-lines across all lung zones and the quartiles of this addition were used for the analyses. Linear regression and Cox regression analyses were performed. The main clinical outcomes were a composite of all-cause death or hospitalization for HF and mortality from any cause.ResultsA total of 577 individuals were included (72% men; 69 ± 12 years). The mean number of B-lines was 5 ± 6. During a mean follow-up of 31 ± 7 months, 157 patients experienced the main clinical outcome and 111 died. Having ≥ 8 B-lines (Q4) doubled the risk of experiencing the composite primary event (P < .001) and increased the risk of death from any cause by 2.6-fold (P < .001). On multivariate analysis, the total sum of B-lines remained independent predictive factor of the composite endpoint (HR, 1.04; 95%CI, 1.02-1.06; P = .002) and of all-cause death (HR, 1.04; 95%CI, 1.02-1.07; P = .001), independently of whether or not N-terminal pro-B-type natriuretic peptide (NT-proBNP) was included in the model (P = .01 and P = .008, respectively), with a 3% to 4% increased risk for each 1-line addition.ConclusionsLUS identified patients with stable chronic HF at high risk of death or HF hospitalization.     

肺超声在军人社区获得性肺炎辅助诊断中的作用

目的 探究肺超声(LUS)技术在军人社区获得性肺炎(CAP)辅助诊断中的作用.方法 选取2019年11月至2020年1月于本院呼吸内科住院、临床怀疑CAP的军人患者58例,最终纳入50例作为患者组,另选取20名健康志愿者作为对照组.入院当天完成LUS、胸部CT和实验室检查,比较两组入院前临床资料、肺超声征象及实验室指标...     

床旁肺超声评估老年慢性阻塞性肺病急性加重合并肺炎的应用价值陈娟,伍倩戎,张雪兰,李琴,陈玲

目的 探讨床旁肺部超声在老年慢性阻塞性肺病急性加重(AECOPD)合并肺炎患者病情评估中的临床应用价值。方法 选取AECOPD合并肺炎患者46例,均行床旁肺超声检查,计算每例患者的肺超声B线数量和肺部超声评分,分析肺部超声评分与氧合指数的相关性；应用ROC曲线分析肺部超声评分和氧合指数对AECOPD合并肺炎的诊断效能。结果46例患者肺部超声评分8.1±2.0。相关性分析显示,肺部超声评分与氧合指数呈负相关(r=-0.69,P<0.05)。ROC曲线分析显示,以肺部超声评分为8.7分为截断值,其诊断AECOPD合并肺炎的敏感性90.8%,特异性87.3%,准确率89.1%,曲线下面积0.814；以氧合指数193 mm Hg为截断值,其诊断AECOPD合并肺炎的敏感性87.2%,特异性83.3%,准确率85.6%,曲线下面积0.779。结论 床旁肺超声能准确评估慢性阻塞性肺病急性加重合并肺炎患者的肺部情况,操作简便易行,可重复性强,具有较好的临床应用价值。